Rate of Uninsured Kids Held Steady Nationwide and Improved in 17 States in 2022

Gains Are At Risk and Inequities Persist

Updated on November 27, 2023, and originally posted September 27, 2022, by the Annie E. Casey Foundation

Update healthinsurance 2022

New data from the Cen­sus Bureau’s Amer­i­can Com­mu­ni­ty Sur­vey show that the U.S. rate of unin­sured chil­dren held steady at 5% in 2022, main­tain­ing the gains of 2021, and 17 states saw their unin­sured rates decline. While this is pos­i­tive news, near­ly 4 mil­lion chil­dren under age 19 still lacked insur­ance cov­er­age in 2022, and expir­ing pan­dem­ic-relief mea­sures in 2023 are already caus­ing num­bers to climb.

Even when children’s unin­sured rates are at their low­est, large dis­par­i­ties per­sist by children’s race and eth­nic­i­ty, immi­gra­tion sta­tus, age and geog­ra­phy, high­light­ing our country’s inequitable access to health cov­er­age that must be addressed.

What Hap­pened Dur­ing the Pandemic

After the COVID-19 pan­dem­ic hit, Con­gress passed mul­ti­ple relief mea­sures that bol­stered the insur­ance safe­ty net for chil­dren and fam­i­lies, including:

  • increased state fund­ing for Med­ic­aid and con­tin­u­ous cov­er­age pro­tec­tion to keep states from dis­en­rolling peo­ple until April 12023;
  • reduced costs for pur­chas­ing cov­er­age through the Afford­able Care Act (ACA) health insur­ance mar­ket­place and expand­ed enroll­ment peri­ods and out­reach; and
  • expand­ed fed­er­al and state mea­sures, such as the Children’s Health Insur­ance Pro­gram (CHIP), to improve access to insurance.

Now that the Med­ic­aid con­tin­u­ous cov­er­age pro­tec­tion expired in ear­ly 2023, an esti­mat­ed 6 mil­lion indi­vid­u­als have already lost cov­er­age this year and this num­ber is expect­ed to rise — unless pol­i­cy­mak­ers take action.

What Are Med­ic­aid and CHIP?

Cen­sus Bureau analy­sis indi­cat­ed that increased enroll­ment in Med­ic­aid and CHIP was behind the reduced U.S. rate of unin­sured chil­dren in 2021, but what do these pro­grams entail?

  • Med­ic­aid is a large pub­lic health insur­ance pro­gram for chil­dren and adults who meet a low-income eli­gi­bil­i­ty thresh­old. Under the ACA, states can expand Med­ic­aid eli­gi­bil­i­ty to more low-income fam­i­lies. In 2022, all but 12 states had expand­ed their Med­ic­aid eli­gi­bil­i­ty require­ments.
  • CHIP is anoth­er pub­lic insur­ance pro­gram for chil­dren in fam­i­lies whose incomes are too high to qual­i­fy for Med­ic­aid but like­ly too low to afford pri­vate insurance.
  • While kids and young adults can be cov­ered under a parent’s or guardian’s insur­ance plan up to age 26, only chil­dren under age 19 can qual­i­fy for Med­ic­aid or CHIP.

One-in-Three Chil­dren Rely on Pub­lic Insurance

Nation­wide, about one-third of kids (34%) received pub­lic health insur­ance in 2022, while near­ly half (48%) were cov­ered through employ­er-based insur­ance. Far few­er chil­dren had oth­er types of cov­er­age, includ­ing a mix­ture of pub­lic and pri­vate insur­ance (5%), a plan pur­chased direct­ly from an insur­ance com­pa­ny (5%) or oth­er pri­vate insur­ance (2%).

At the state lev­el, the share of kids who rely on pub­lic insur­ance ranged from 14% in Utah to more than half (52%) in New Mex­i­co in 2022.

Why Insur­ing Chil­dren Matters

Kids with insur­ance are more like­ly to access time­ly med­ical care for health needs. They have improved phys­i­cal, men­tal and behav­ioral health out­comes com­pared to those with­out cov­er­age. Poor health dur­ing child­hood can affect vir­tu­al­ly every area of a child’s life, includ­ing school per­for­mance, and can have last­ing con­se­quences on health, well-being and finan­cial secu­ri­ty into adulthood.

Chil­dren eli­gi­ble for pub­lic insur­ance are espe­cial­ly like­ly to see the ben­e­fits of health cov­er­age, includ­ing increased eco­nom­ic sta­bil­i­ty for their fam­i­lies. For instance, when a fam­i­ly receives Med­ic­aid, they can use more of their income on oth­er basic needs like food and hous­ing. Med­ic­aid has also been linked to reduced med­ical debt and bank­rupt­cies, and it is con­sid­ered one of the nation’s lead­ing anti-pover­ty programs.

Insur­ing par­ents helps chil­dren, too. It increas­es the like­li­hood of parental health and strength­ens par­ents’ abil­i­ty to care for their children.

Children’s Risk of Being Unin­sured Varies by State

Dif­fer­ences in state poli­cies and prac­tices, as well as local eco­nom­ic con­di­tions, large­ly influ­ence the vari­a­tion in access to cov­er­age across the coun­try. Over­all, chil­dren are more like­ly to lack insur­ance in the South­ern and West­ern regions of the nation. In 2022, the North­east states of Mass­a­chu­setts and Rhode Island had the low­est unin­sured rates (both 2%), while Texas had the high­est rate, with 11% — or 854,000 kids — lack­ing insurance.


How­ev­er, Texas was among the 17 states that improved in 2022, with its rate of unin­sured chil­dren declin­ing by one per­cent­age point since 2021. The oth­er 16 states and the Dis­trict of Colum­bia that made gains in 2022 also saw declines of one to three per­cent­age points. Despite this progress, rates of unin­sured chil­dren increased in sev­en states in 2022, each by one per­cent­age point.

Inequities Per­sist, Par­tic­u­lar­ly for Amer­i­can Indi­an and Alas­ka Native Children

The rate of unin­sured Amer­i­can Indi­an and Alas­ka Native chil­dren has been more than twice the nation­al rate in all five years of data avail­able on the KIDS COUNT Data Cen­ter, although the per­cent­age for these kids improved for the sec­ond year in a row from 14% in 2019 to 11% in 2022. The unin­sured rate for Lati­no chil­dren has also remained high­er than the nation­al lev­el for five years but fell by one per­cent­age point to 8% in 2022. Black chil­dren saw a slight improve­ment as well, from 5% to 4% of kids with­out insur­ance. From 2021 to 2022, fig­ures remained even for kids of two or more races (6%), white kids (4%) and Asian and Pacif­ic Islander (4%) children.

In addi­tion, immi­grant chil­dren, par­tic­u­lar­ly those who are undoc­u­ment­ed, are at increased risk of being unin­sured com­pared to their peers with U.S. cit­i­zen­ship. The Cen­sus Bureau report­ed that 1 in 4 (25%) non-cit­i­zen chil­dren were unin­sured in 2022, an increase from 23% in 2021. Fig­ures were near­ly as high for for­eign-born kids as a whole, regard­less of citizenship.

Young adults are vul­ner­a­ble, too, as they are the most like­ly of any age group to be unin­sured. The most recent data from the Cen­sus Bureau’s House­hold Pulse Sur­vey in the fall of 2022 showed that 17% of young adults ages 18 to 24 lacked health insurance.

Address­ing Inequities and Bar­ri­ers to Health Insurance

Although pan­dem­ic-era poli­cies helped many chil­dren and fam­i­lies access and keep cov­er­age dur­ing this nation­al health cri­sis, mil­lions of chil­dren and young adults still lack health insur­ance, and con­cern­ing dis­par­i­ties in access to cov­er­age remain. Con­cert­ed action is also need­ed just to main­tain the gains made in recent years, rec­og­niz­ing that as the fed­er­al man­date for states to ensure con­tin­u­ous Med­ic­aid cov­er­age has end­ed. States, too, can take action to keep eli­gi­ble fam­i­lies enrolled in Med­ic­aid or help them enroll in oth­er plans. Fed­er­al law­mak­ers can also make per­ma­nent the pan­dem­ic-era improve­ments to the ACA mar­ket­place, as these were effec­tive in increas­ing cov­er­age but will expire after 2025.

Pol­i­cy­mak­ers and lead­ers in mul­ti­ple sec­tors must con­tin­ue work­ing toward sys­temic change to address the long-stand­ing inequities and bar­ri­ers that con­tribute to the dis­pro­por­tion­ate­ly high unin­sured rates among Amer­i­can Indi­an/​Alaska Native and Lati­no chil­dren. Addi­tion­al­ly, lead­ers should remove bar­ri­ers for immi­grant fam­i­lies to enroll­ment in Med­ic­aid and the ACA health insur­ance mar­ket­place, and sup­port strate­gies to increase enroll among young adults. Lead­ers at all lev­els can take steps to sim­pli­fy the sys­tem and improve access to cov­er­age, par­tic­u­lar­ly for the most vul­ner­a­ble populations.

More Child and Fam­i­ly Health Resources

See all health insur­ance data on the KIDS COUNT Data Cen­ter, includ­ing these new­ly updat­ed indicators:

Addi­tion­al resources:

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